Adrenal tumors and pregnancy
Adrenal tumors and pregnancy
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DOI：
10.1007/pl00013159
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发表时间：
1999-02-01
影响因子：
2.6
通讯作者：
Ramin, KD
中科院分区：
文献类型：
--
作者：
Harrington, JL;Farley, DR;Ramin, KD
虽然在怀孕期间发现肾上腺肿瘤是非常罕见的，未经治疗的肾上腺肿瘤的病理生理影响是巨大的母亲和胎儿。从1975年至1916年的妊娠患者（n = 30，246）的计算机登记中，确定了4例与妊娠相关的肾上腺肿瘤（0.013%），进行了分析，并与当前的医学文献进行了比较。4名年龄分别为36岁、29岁、22岁和21岁的女性被诊断为肾上腺肿瘤并妊娠。患者1在尸检时发现了未怀疑的嗜铬细胞瘤。在怀孕27周时，患者发生心肌梗死，她和胎儿都死亡。患者2在腹部计算机断层扫描筛查von Hippel-Lindau病时意外发现肾上腺和胰腺肿瘤。该研究发现了怀孕。她选择终止妊娠，并接受了两个肿瘤的切除术。3年后死于转移性胰岛细胞癌。这两名患者以前都曾分娩过健康的婴儿，但两次妊娠都并发高血压。患者3有一个功能性肾上腺肿瘤，最初通过尿醛固酮研究确定，因为严重的高血压症状，和患者4有一个肾上腺肿块，通过超声诊断在妊娠30周，因为担心右侧肾盂肾炎。这两名妇女在怀孕的剩余时间里接受了仔细的监测，最终生下了健康的婴儿。这两名妇女后来接受了成功的手术切除良性肾上腺腺瘤，肾上腺肿瘤发现在怀孕期间是罕见的。然而，对于有高血压、头痛或其他肾上腺疾病表现的孕妇，医生有责任考虑这种诊断。经鉴定的肾上腺病变的手术治疗是简单的。错过诊断对这些年轻女性和她们的胎儿有着严重的影响。
Although adrenal tumors detected during pregnancy are extraordinarily rare, the pathophysiologic repercussions of untreated adrenal neoplasms are enormous to both mother and fetus. From our computer-based registry of pregnant patients from 1975 through 1916 (n = 30,246), four cases of adrenal neoplasms associated with pregnancy were identified (0.013%), analyzed, and compared with the current medical literature. Four women ages 36, 29, 22, and 21 years had adrenal neoplasms diagnosed with pregnancy. Patient 1 had an unsuspected pheochromocytoma identified at autopsy. At 27 weeks into her pregnancy the patient suffered a myocardial infarction, and both she and the fetus died. Patient 2 was incidentially found to have adrenal and pancreatic neoplasms on screening abdominal computed tomography for von Hippel-Lindau disease. The study identified a pregnancy. She elected to terminate the pregnancy and underwent resection of both tumors. She died 3 years later of metastatic islet cell canter. Both of these patients had previously delivered healthy babies, but both pregnancies were complicated by hypertension. Patient 3 had a functional adrenal tumor identified initially by urinary aldosterone studies because of symptoms of severe hypertension, and patient 4 had an adrenal mass diagnosed via ultrasonography at 30 weeks' gestation because of concerns for right-sided pyelonephritis. These two women underwent careful monitoring throughout the remainder of their pregnancies with eventual delivery of healthy babies. Both women later underwent successful operative resection of benign adrenal adenomas, Adrenal neoplasms discovered during pregnancy are rare. The onus, however, is on physicians to consider this diagnosis in pregnant women with hypertension, headaches, or other manifestations of adrenal disorders. Surgical management of identified adrenal lesions is thereafter straightforward. Missing the diagnosis has grave implications for these young women and their fetuses.